Objective:
Compared to a standard diet and exercise intervention, mindfulness based stress reduction and eating behavior in obese people will lead to improved eating patterns and metabolic health.

Approach:
A randomized, controlled trial to compare a standard diet and exercise intervention for obesity (BMI 30 to 45) to an enhanced version will be conducted. The enhanced version includes mindfulness-based eating awareness and stress reduction components. The intervention period consists of 16, 2-2.5 hour weekly sessions over 22 weeks. Plasma and serum samples are obtained at baseline, 3, 6, 12, and 18 months. Additional measures include: questionnaires (stress, mood, eating behavior, 24 hour diet recall), diurnal salivary cortisol, pre-post intervention Trier Social Stress test for stress reactivity with Autonomic Nervous System and cortisol responses, gene expression in leukocytes, and fat distribution (by MRI). In order to address one of the primary questions, whether group assignment (standard diet & exercise vs. stress reduction + standard diet & exercise) and changes in stress and stress reactivity alter biomarkers of inflammation and insulin resistance, a series of selected assays, using batched serum/plasma specimens collected at the said times across the intervention, will be conducted to determine markers of metabolic (e.g., insulin; lipoprotein fractionation) and inflammatory (IL-6; IL-10; HS-CRP) status.